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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1998 March;17(1):53-7

language: English

Importance of cuta­ne­ous pos­tu­ral ­reflex vaso­con­stric­tion in ­patients with ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower extrem­ities

Vayssairat M., Tribout L., Gouny P. *, Gaitz J. P., Baudot N., Cheynel C. *, Nussaume O. *

From the Unit of Vascular Medicine and * Department of Vascular Surgery, Tenon Hospital, Paris, France


Objective. The ­present study was ­designed to meas­ure the cuta­ne­ous pos­tu­ral vas­o­con­stric­tive ­reflex (PVR) in nor­mal con­trols and ­patients with ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower extrem­ities, and to deter­mine its diag­nos­tic and prog­nos­tic rel­e­vance.
Experimental ­design. The pos­tu­ral vas­o­con­stric­tive ­reflex was record­ed in 34 ­patients with ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower limbs and 27 nor­mal con­trols, using laser-Doppler flow­me­try. Patients also had ankle and toe pres­sure meas­ure­ments and trans­cu­ta­ne­ous oxim­e­try (TcPO2).
Setting. University hos­pi­tal.
Results. The PVR on the pulp of the big toe was 20±7 arbi­trary per­fu­sion units in nor­mal con­trols, 9.4±12 in ­patients with claud­i­ca­tion, and -19±5 in ­patients with rest pain and/or gan­grene, who dif­fered from the clau­di­cant and con­trol ­groups (p=0.001 and 0.0001 respec­tive­ly). The sen­si­tiv­ity of neg­a­tive PVR in the big toe was 89% for the diag­no­sis of rest pain and/or gan­grene, and its spec­i­fic­ity, 83%. The sever­ity of foot ischae­mia and PVR val­ues exhib­it­ed a sig­nif­i­cant ­inverse cor­re­la­tion (r=-0.56, p<0.0001). All ­patients with a poor out­come, ie. death and/or major ampu­ta­tion with­in 100 days of fol­low-up, had a neg­a­tive PVR, and all ­patients with a pos­i­tive PVR had a good 100-day prog­no­sis with­out even a minor ampu­ta­tion.
Conclusions. Laser-Doppler pro­vides use­ful addi­tion­al infor­ma­tion in the assess­ment of foot ischae­mia sever­ity by show­ing that pos­tu­ral vaso­con­stric­tion is ­impaired in ­patients with ­severe ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower limbs, result­ing in ­increased skin micro­cir­cu­la­to­ry flow dur­ing leg depen­den­cy.

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